Madison Medical Center

All Charges

Charge

Type

Setting

Price

.COVID 19 PCR (INTERFACE AEL)

Facility

$226.00

Service Code	CPT 87635
Hospital Charge Code	2287638
Hospital Revenue Code	306
Min. Negotiated Rate	$21.00
Max. Negotiated Rate	$161.36
Rate for Payer: Aetna Better Health Medicaid/QHP	$46.18
Rate for Payer: Aetna Medicare Advantage	$51.31
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$133.79
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$161.36
Rate for Payer: Cash Price	$203.40
Rate for Payer: Cash Price	$203.40
Rate for Payer: Cash Price	$203.40
Rate for Payer: Cigna Commercial HMO & PPO	$51.31
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$46.18
Rate for Payer: Home State Health Plan Medicaid Managed Care	$49.41
Rate for Payer: Home State Health Plan Medicare Advantage	$51.31
Rate for Payer: Humana Commercial	$102.62
Rate for Payer: Humana Medicare Advantage	$51.31
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$46.18
Rate for Payer: UnitedHealthcare Medicare Advantage	$81.36

.COVID 19 PCR (LABCORP)

Facility

$258.00

Service Code	CPT U0003
Hospital Charge Code	2287635
Hospital Revenue Code	306
Min. Negotiated Rate	$21.00
Max. Negotiated Rate	$184.21
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$152.74
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$184.21
Rate for Payer: Cash Price	$232.20
Rate for Payer: Cash Price	$232.20
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$92.88

.COVID 19 PCR (LABCORP)

Facility

$258.00

Service Code	CPT U0003
Hospital Charge Code	2287635
Hospital Revenue Code	306
Rate for Payer: Cash Price	$232.20

C-PAP MACHINE (2 WEEK CHARGE)

Facility

$362.00

Hospital Charge Code	281030
Hospital Revenue Code	271
Rate for Payer: Cash Price	$325.80

C-PAP MACHINE (2 WEEK CHARGE)

Facility

$362.00

Hospital Charge Code	281030
Hospital Revenue Code	271
Min. Negotiated Rate	$130.32
Max. Negotiated Rate	$258.47
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$214.30
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$258.47
Rate for Payer: Cash Price	$325.80
Rate for Payer: UnitedHealthcare Commercial	$241.45
Rate for Payer: UnitedHealthcare Medicare Advantage	$130.32

CPAP SETUP

Facility

$264.00

Service Code	CPT 94660
Hospital Charge Code	4500211
Hospital Revenue Code	271
Min. Negotiated Rate	$95.04
Max. Negotiated Rate	$447.44
Rate for Payer: Aetna Better Health Medicaid/QHP	$197.40
Rate for Payer: Aetna Medicare Advantage	$223.72
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$156.29
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$188.50
Rate for Payer: Cash Price	$237.60
Rate for Payer: Cash Price	$237.60
Rate for Payer: Cash Price	$237.60
Rate for Payer: Cigna Commercial HMO & PPO	$223.72
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$197.40
Rate for Payer: Home State Health Plan Medicaid Managed Care	$211.22
Rate for Payer: Home State Health Plan Medicare Advantage	$223.72
Rate for Payer: Humana Commercial	$447.44
Rate for Payer: Humana Medicare Advantage	$223.72
Rate for Payer: UnitedHealthcare Commercial	$176.09
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$197.40
Rate for Payer: UnitedHealthcare Medicare Advantage	$95.04

CPAP SETUP

Facility

$264.00

Service Code	CPT 94660
Hospital Charge Code	4500211
Hospital Revenue Code	271
Rate for Payer: Cash Price	$237.60

CPAP SUBSEQUENT PER HOUR

Facility

$55.00

Service Code	CPT 94662
Hospital Charge Code	4500220
Hospital Revenue Code	412
Min. Negotiated Rate	$19.80
Max. Negotiated Rate	$39.27
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$32.56
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$39.27
Rate for Payer: Cash Price	$49.50
Rate for Payer: UnitedHealthcare Commercial	$36.69
Rate for Payer: UnitedHealthcare Medicare Advantage	$19.80

CPAP SUBSEQUENT PER HOUR

Facility

$55.00

Service Code	CPT 94662
Hospital Charge Code	4500220
Hospital Revenue Code	412
Rate for Payer: Cash Price	$49.50

CPEPTIDE

Facility

$156.00

Service Code	CPT 84681
Hospital Charge Code	2284681
Hospital Revenue Code	301
Rate for Payer: Cash Price	$140.40

CPEPTIDE

Facility

$156.00

Service Code	CPT 84681
Hospital Charge Code	2284681
Hospital Revenue Code	301
Min. Negotiated Rate	$18.73
Max. Negotiated Rate	$111.38
Rate for Payer: Aetna Better Health Medicaid/QHP	$18.73
Rate for Payer: Aetna Medicare Advantage	$20.81
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$92.35
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$111.38
Rate for Payer: Cash Price	$140.40
Rate for Payer: Cash Price	$140.40
Rate for Payer: Cash Price	$140.40
Rate for Payer: Cigna Commercial HMO & PPO	$20.81
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$18.73
Rate for Payer: Home State Health Plan Medicaid Managed Care	$20.04
Rate for Payer: Home State Health Plan Medicare Advantage	$20.81
Rate for Payer: Humana Commercial	$41.62
Rate for Payer: Humana Medicare Advantage	$20.81
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$18.73
Rate for Payer: UnitedHealthcare Medicare Advantage	$56.16

CPK

Facility

$153.00

Service Code	CPT 82550
Hospital Charge Code	223131
Hospital Revenue Code	301
Rate for Payer: Cash Price	$137.70

CPK

Facility

$153.00

Service Code	CPT 82550
Hospital Charge Code	223131
Hospital Revenue Code	301
Min. Negotiated Rate	$5.86
Max. Negotiated Rate	$109.24
Rate for Payer: Aetna Better Health Medicaid/QHP	$5.86
Rate for Payer: Aetna Medicare Advantage	$6.51
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$90.58
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$109.24
Rate for Payer: Cash Price	$137.70
Rate for Payer: Cash Price	$137.70
Rate for Payer: Cash Price	$137.70
Rate for Payer: Cigna Commercial HMO & PPO	$6.51
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$5.86
Rate for Payer: Home State Health Plan Medicaid Managed Care	$6.27
Rate for Payer: Home State Health Plan Medicare Advantage	$6.51
Rate for Payer: Humana Commercial	$13.02
Rate for Payer: Humana Medicare Advantage	$6.51
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$5.86
Rate for Payer: UnitedHealthcare Medicare Advantage	$55.08

CPK (LABCORP)

Facility

$153.00

Service Code	CPT 82550
Hospital Charge Code	223132
Hospital Revenue Code	301
Rate for Payer: Cash Price	$137.70

CPK (LABCORP)

Facility

$153.00

Service Code	CPT 82550
Hospital Charge Code	223132
Hospital Revenue Code	301
Min. Negotiated Rate	$5.86
Max. Negotiated Rate	$109.24
Rate for Payer: Aetna Better Health Medicaid/QHP	$5.86
Rate for Payer: Aetna Medicare Advantage	$6.51
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$90.58
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$109.24
Rate for Payer: Cash Price	$137.70
Rate for Payer: Cash Price	$137.70
Rate for Payer: Cash Price	$137.70
Rate for Payer: Cigna Commercial HMO & PPO	$6.51
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$5.86
Rate for Payer: Home State Health Plan Medicaid Managed Care	$6.27
Rate for Payer: Home State Health Plan Medicare Advantage	$6.51
Rate for Payer: Humana Commercial	$13.02
Rate for Payer: Humana Medicare Advantage	$6.51
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$5.86
Rate for Payer: UnitedHealthcare Medicare Advantage	$55.08

CP LAG SCREW 4.1MMX22MM (T10)

Facility

$760.00

Hospital Charge Code	123502
Hospital Revenue Code	271
Rate for Payer: Cash Price	$684.00

CP LAG SCREW 4.1MMX22MM (T10)

Facility

$760.00

Hospital Charge Code	123502
Hospital Revenue Code	271
Min. Negotiated Rate	$273.60
Max. Negotiated Rate	$542.64
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$449.92
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$542.64
Rate for Payer: Cash Price	$684.00
Rate for Payer: UnitedHealthcare Commercial	$506.92
Rate for Payer: UnitedHealthcare Medicare Advantage	$273.60

CP LAG SCREW 4.1MMX24MM (STRYKER)

Facility

$762.00

Hospital Charge Code	123402
Hospital Revenue Code	271
Min. Negotiated Rate	$274.32
Max. Negotiated Rate	$544.07
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$451.10
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$544.07
Rate for Payer: Cash Price	$685.80
Rate for Payer: UnitedHealthcare Commercial	$508.25
Rate for Payer: UnitedHealthcare Medicare Advantage	$274.32

CP LAG SCREW 4.1MMX24MM (STRYKER)

Facility

$762.00

Hospital Charge Code	123402
Hospital Revenue Code	271
Rate for Payer: Cash Price	$685.80

CPO HH PATIENT <30 MIN

Facility

$180.00

Service Code	CPT 99374
Hospital Charge Code	4499374
Hospital Revenue Code	521
Min. Negotiated Rate	$106.56
Max. Negotiated Rate	$173.53
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$106.56
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$128.52
Rate for Payer: Cash Price	$162.00
Rate for Payer: Cash Price	$162.00
Rate for Payer: UnitedHealthcare Commercial	$120.06
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

CPO HH PATIENT <30 MIN

Facility

$180.00

Service Code	CPT 99374
Hospital Charge Code	4499374
Hospital Revenue Code	521
Rate for Payer: Cash Price	$162.00

CPO HH PATIENT >30 MIN

Facility

$260.00

Service Code	CPT 99375
Hospital Charge Code	4499375
Hospital Revenue Code	521
Rate for Payer: Cash Price	$234.00

CPO HH PATIENT >30 MIN

Facility

$260.00

Service Code	CPT 99375
Hospital Charge Code	4499375
Hospital Revenue Code	521
Min. Negotiated Rate	$153.92
Max. Negotiated Rate	$185.64
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$153.92
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$185.64
Rate for Payer: Cash Price	$234.00
Rate for Payer: Cash Price	$234.00
Rate for Payer: UnitedHealthcare Commercial	$173.42
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

CPO HH PT <30 MIN

Facility

$173.00

Service Code	CPT 99374
Hospital Charge Code	4299374
Hospital Revenue Code	521
Min. Negotiated Rate	$102.42
Max. Negotiated Rate	$173.53
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$102.42
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$123.52
Rate for Payer: Cash Price	$155.70
Rate for Payer: Cash Price	$155.70
Rate for Payer: UnitedHealthcare Commercial	$115.39
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

CPO HH PT <30 MIN

Facility

$180.00

Service Code	CPT 99374
Hospital Charge Code	5299374
Hospital Revenue Code	521
Rate for Payer: Cash Price	$162.00

Know your out-of-pocket cost for care.

All Charges